Provider Demographics
NPI:1467151266
Name:CARDENAS, JEANNE CAMILLE
Entity type:Individual
Prefix:
First Name:JEANNE
Middle Name:CAMILLE
Last Name:CARDENAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 E SUPERIOR ST STE 9-900
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-4494
Mailing Address - Country:US
Mailing Address - Phone:312-503-7975
Mailing Address - Fax:312-503-5230
Practice Address - Street 1:420 E SUPERIOR ST STE 9-900
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-4494
Practice Address - Country:US
Practice Address - Phone:312-503-7975
Practice Address - Fax:312-503-5230
Is Sole Proprietor?:No
Enumeration Date:2023-03-01
Last Update Date:2024-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125083327207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology